|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$50.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
77002
|
| Min. Negotiated Rate |
$42.18 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Aetna American Axle |
$74.10
|
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Medicare |
$57.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$74.10
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$79.80
|
| Rate for Payer: Cofinity Commercial |
$98.04
|
| Rate for Payer: Cofinity Medicare Advantage |
$79.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$91.20
|
| Rate for Payer: Healthscope Commercial |
$102.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$79.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$85.50
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$96.90
|
| Rate for Payer: PHP Commercial |
$96.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health SBD |
$71.82
|
| Rate for Payer: UMR Bronson Commercial |
$42.18
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$85.50
|
|
|
CHG FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
HCPCS 77002
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$147.43 |
| Rate for Payer: Aetna Commercial |
$137.19
|
| Rate for Payer: Aetna Medicare |
$106.48
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$147.43
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$137.19
|
| Rate for Payer: BCBS Complete |
$45.60
|
| Rate for Payer: BCBS MAPPO |
$102.38
|
| Rate for Payer: BCN Medicare Advantage |
$102.38
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cash Price |
$91.20
|
| Rate for Payer: Cofinity Commercial |
$147.43
|
| Rate for Payer: Cofinity Commercial |
$137.19
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$102.38
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$107.50
|
| Rate for Payer: Nomi Health Commercial |
$122.86
|
| Rate for Payer: PACE SWMI |
$102.38
|
| Rate for Payer: PHP Commercial |
$143.33
|
| Rate for Payer: PHP Medicare Advantage |
$102.38
|
| Rate for Payer: Priority Health Cigna Priority Health |
$74.10
|
| Rate for Payer: Priority Health Medicare |
$102.38
|
| Rate for Payer: UHC Dual Complete DSNP |
$102.38
|
| Rate for Payer: UHC Medicare Advantage |
$102.38
|
| Rate for Payer: UMR Bronson Commercial |
$52.44
|
|
|
CHG FLUOROSCOPY SPX >1 HOUR PHYS/QHP TIME
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS 76001
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$43.55 |
| Rate for Payer: Aetna Medicare |
$33.50
|
| Rate for Payer: BCBS Complete |
$26.80
|
| Rate for Payer: Cash Price |
$53.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.55
|
| Rate for Payer: UMR Bronson Commercial |
$30.82
|
|
|
CHG FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
HCPCS 76000
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$56.48 |
| Rate for Payer: Aetna Commercial |
$52.55
|
| Rate for Payer: Aetna Medicare |
$40.79
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$52.55
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$56.48
|
| Rate for Payer: BCBS Complete |
$22.00
|
| Rate for Payer: BCBS MAPPO |
$39.22
|
| Rate for Payer: BCN Medicare Advantage |
$39.22
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cofinity Commercial |
$52.55
|
| Rate for Payer: Cofinity Commercial |
$56.48
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$39.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$41.18
|
| Rate for Payer: Nomi Health Commercial |
$47.06
|
| Rate for Payer: PACE SWMI |
$39.22
|
| Rate for Payer: PHP Commercial |
$54.91
|
| Rate for Payer: PHP Medicare Advantage |
$39.22
|
| Rate for Payer: Priority Health Cigna Priority Health |
$35.75
|
| Rate for Payer: Priority Health Medicare |
$39.22
|
| Rate for Payer: UHC Dual Complete DSNP |
$39.22
|
| Rate for Payer: UHC Medicare Advantage |
$39.22
|
| Rate for Payer: UMR Bronson Commercial |
$25.30
|
|
|
CHG GASTROESOPHAGEAL REFLUX STUDY
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
HCPCS 78262
|
| Min. Negotiated Rate |
$41.20 |
| Max. Negotiated Rate |
$287.12 |
| Rate for Payer: Aetna Commercial |
$267.18
|
| Rate for Payer: Aetna Medicare |
$207.37
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$287.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$267.18
|
| Rate for Payer: BCBS Complete |
$41.20
|
| Rate for Payer: BCBS MAPPO |
$199.39
|
| Rate for Payer: BCN Medicare Advantage |
$199.39
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cash Price |
$82.40
|
| Rate for Payer: Cofinity Commercial |
$287.12
|
| Rate for Payer: Cofinity Commercial |
$267.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$199.39
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$209.36
|
| Rate for Payer: Nomi Health Commercial |
$239.27
|
| Rate for Payer: PACE SWMI |
$199.39
|
| Rate for Payer: PHP Commercial |
$279.15
|
| Rate for Payer: PHP Medicare Advantage |
$199.39
|
| Rate for Payer: Priority Health Cigna Priority Health |
$66.95
|
| Rate for Payer: Priority Health Medicare |
$199.39
|
| Rate for Payer: UHC Dual Complete DSNP |
$199.39
|
| Rate for Payer: UHC Medicare Advantage |
$199.39
|
| Rate for Payer: UMR Bronson Commercial |
$47.38
|
|
|
CHG GLUC BLD GLUC MNTR DEV CLEARED FDA SPEC HOME USE
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS 82962
|
| Min. Negotiated Rate |
$3.28 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Aetna Commercial |
$4.40
|
| Rate for Payer: Aetna Medicare |
$3.41
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.72
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$4.40
|
| Rate for Payer: BCBS Complete |
$4.80
|
| Rate for Payer: BCBS MAPPO |
$3.28
|
| Rate for Payer: BCN Medicare Advantage |
$3.28
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cofinity Commercial |
$4.72
|
| Rate for Payer: Cofinity Commercial |
$4.40
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.28
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$3.44
|
| Rate for Payer: Nomi Health Commercial |
$3.94
|
| Rate for Payer: PACE SWMI |
$3.28
|
| Rate for Payer: PHP Commercial |
$4.59
|
| Rate for Payer: PHP Medicare Advantage |
$3.28
|
| Rate for Payer: Priority Health Cigna Priority Health |
$7.80
|
| Rate for Payer: Priority Health Medicare |
$3.28
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.28
|
| Rate for Payer: UHC Medicare Advantage |
$3.28
|
| Rate for Payer: UMR Bronson Commercial |
$5.52
|
|
|
CHG GLUCOSE BLOOD REAGENT STRIP
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
HCPCS 82948
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$9.10 |
| Rate for Payer: Aetna Commercial |
$6.75
|
| Rate for Payer: Aetna Medicare |
$5.24
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.26
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.75
|
| Rate for Payer: BCBS Complete |
$5.60
|
| Rate for Payer: BCBS MAPPO |
$5.04
|
| Rate for Payer: BCN Medicare Advantage |
$5.04
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cash Price |
$11.20
|
| Rate for Payer: Cofinity Commercial |
$7.26
|
| Rate for Payer: Cofinity Commercial |
$6.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.04
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.29
|
| Rate for Payer: Nomi Health Commercial |
$6.05
|
| Rate for Payer: PACE SWMI |
$5.04
|
| Rate for Payer: PHP Commercial |
$7.06
|
| Rate for Payer: PHP Medicare Advantage |
$5.04
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.10
|
| Rate for Payer: Priority Health Medicare |
$5.04
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.04
|
| Rate for Payer: UHC Medicare Advantage |
$5.04
|
| Rate for Payer: UMR Bronson Commercial |
$6.44
|
|
|
CHG GLUCOSE QUANTITATIVE BLOOD XCPT REAGENT STRIP
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS 82947
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Aetna Commercial |
$5.27
|
| Rate for Payer: Aetna Medicare |
$4.09
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$5.27
|
| Rate for Payer: BCBS Complete |
$6.80
|
| Rate for Payer: BCBS MAPPO |
$3.93
|
| Rate for Payer: BCN Medicare Advantage |
$3.93
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cash Price |
$13.60
|
| Rate for Payer: Cofinity Commercial |
$5.66
|
| Rate for Payer: Cofinity Commercial |
$5.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$3.93
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$4.13
|
| Rate for Payer: Nomi Health Commercial |
$4.72
|
| Rate for Payer: PACE SWMI |
$3.93
|
| Rate for Payer: PHP Commercial |
$5.50
|
| Rate for Payer: PHP Medicare Advantage |
$3.93
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.05
|
| Rate for Payer: Priority Health Medicare |
$3.93
|
| Rate for Payer: UHC Dual Complete DSNP |
$3.93
|
| Rate for Payer: UHC Medicare Advantage |
$3.93
|
| Rate for Payer: UMR Bronson Commercial |
$7.82
|
|
|
CHG GLUCOSE TOLERANCE TEST GTT 3 SPECIMENS
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
HCPCS 82951
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$30.55 |
| Rate for Payer: Aetna Commercial |
$17.25
|
| Rate for Payer: Aetna Medicare |
$13.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.25
|
| Rate for Payer: BCBS Complete |
$18.80
|
| Rate for Payer: BCBS MAPPO |
$12.87
|
| Rate for Payer: BCN Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cash Price |
$37.60
|
| Rate for Payer: Cofinity Commercial |
$18.53
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$12.87
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.51
|
| Rate for Payer: Nomi Health Commercial |
$15.44
|
| Rate for Payer: PACE SWMI |
$12.87
|
| Rate for Payer: PHP Commercial |
$18.02
|
| Rate for Payer: PHP Medicare Advantage |
$12.87
|
| Rate for Payer: Priority Health Cigna Priority Health |
$30.55
|
| Rate for Payer: Priority Health Medicare |
$12.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$12.87
|
| Rate for Payer: UHC Medicare Advantage |
$12.87
|
| Rate for Payer: UMR Bronson Commercial |
$21.62
|
|
|
CHG GONADOTROPIN CHORIONIC QUALITATIVE
|
Professional
|
Both
|
$26.00
|
|
|
Service Code
|
HCPCS 84703
|
| Min. Negotiated Rate |
$7.52 |
| Max. Negotiated Rate |
$16.90 |
| Rate for Payer: Aetna Commercial |
$10.08
|
| Rate for Payer: Aetna Medicare |
$7.82
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$10.08
|
| Rate for Payer: BCBS Complete |
$10.40
|
| Rate for Payer: BCBS MAPPO |
$7.52
|
| Rate for Payer: BCN Medicare Advantage |
$7.52
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cash Price |
$20.80
|
| Rate for Payer: Cofinity Commercial |
$10.83
|
| Rate for Payer: Cofinity Commercial |
$10.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$7.90
|
| Rate for Payer: Nomi Health Commercial |
$9.02
|
| Rate for Payer: PACE SWMI |
$7.52
|
| Rate for Payer: PHP Commercial |
$10.53
|
| Rate for Payer: PHP Medicare Advantage |
$7.52
|
| Rate for Payer: Priority Health Cigna Priority Health |
$16.90
|
| Rate for Payer: Priority Health Medicare |
$7.52
|
| Rate for Payer: UHC Dual Complete DSNP |
$7.52
|
| Rate for Payer: UHC Medicare Advantage |
$7.52
|
| Rate for Payer: UMR Bronson Commercial |
$11.96
|
|
|
CHG GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
HCPCS 77387
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$39.00 |
| Rate for Payer: Aetna Medicare |
$30.00
|
| Rate for Payer: BCBS Complete |
$24.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$39.00
|
| Rate for Payer: UMR Bronson Commercial |
$27.60
|
|
|
CHG HDR RDNCL NTRSTL/INTRCAV BRACHYTX 1 CHANNEL
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS 77770
|
| Min. Negotiated Rate |
$256.00 |
| Max. Negotiated Rate |
$454.68 |
| Rate for Payer: Aetna Commercial |
$423.11
|
| Rate for Payer: Aetna Commercial |
$423.11
|
| Rate for Payer: Aetna Medicare |
$328.38
|
| Rate for Payer: Aetna Medicare |
$328.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$423.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$454.68
|
| Rate for Payer: BCBS Complete |
$82.80
|
| Rate for Payer: BCBS Complete |
$256.00
|
| Rate for Payer: BCBS MAPPO |
$315.75
|
| Rate for Payer: BCBS MAPPO |
$315.75
|
| Rate for Payer: BCN Medicare Advantage |
$315.75
|
| Rate for Payer: BCN Medicare Advantage |
$315.75
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cash Price |
$512.00
|
| Rate for Payer: Cofinity Commercial |
$454.68
|
| Rate for Payer: Cofinity Commercial |
$423.11
|
| Rate for Payer: Cofinity Commercial |
$454.68
|
| Rate for Payer: Cofinity Commercial |
$423.11
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.75
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$315.75
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.54
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$331.54
|
| Rate for Payer: Nomi Health Commercial |
$378.90
|
| Rate for Payer: Nomi Health Commercial |
$378.90
|
| Rate for Payer: PACE SWMI |
$315.75
|
| Rate for Payer: PACE SWMI |
$315.75
|
| Rate for Payer: PHP Commercial |
$442.05
|
| Rate for Payer: PHP Commercial |
$442.05
|
| Rate for Payer: PHP Medicare Advantage |
$315.75
|
| Rate for Payer: PHP Medicare Advantage |
$315.75
|
| Rate for Payer: Priority Health Cigna Priority Health |
$416.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$134.55
|
| Rate for Payer: Priority Health Medicare |
$315.75
|
| Rate for Payer: Priority Health Medicare |
$315.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.75
|
| Rate for Payer: UHC Dual Complete DSNP |
$315.75
|
| Rate for Payer: UHC Medicare Advantage |
$315.75
|
| Rate for Payer: UHC Medicare Advantage |
$315.75
|
| Rate for Payer: UMR Bronson Commercial |
$95.22
|
| Rate for Payer: UMR Bronson Commercial |
$294.40
|
|
|
CHG HEMOGLOBIN GLYCOSYLATED A1C
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
HCPCS 83036
|
| Min. Negotiated Rate |
$9.20 |
| Max. Negotiated Rate |
$14.95 |
| Rate for Payer: Aetna Commercial |
$13.01
|
| Rate for Payer: Aetna Medicare |
$10.10
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$13.01
|
| Rate for Payer: BCBS Complete |
$9.20
|
| Rate for Payer: BCBS MAPPO |
$9.71
|
| Rate for Payer: BCN Medicare Advantage |
$9.71
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cash Price |
$18.40
|
| Rate for Payer: Cofinity Commercial |
$13.98
|
| Rate for Payer: Cofinity Commercial |
$13.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$9.71
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$10.20
|
| Rate for Payer: Nomi Health Commercial |
$11.65
|
| Rate for Payer: PACE SWMI |
$9.71
|
| Rate for Payer: PHP Commercial |
$13.59
|
| Rate for Payer: PHP Medicare Advantage |
$9.71
|
| Rate for Payer: Priority Health Cigna Priority Health |
$14.95
|
| Rate for Payer: Priority Health Medicare |
$9.71
|
| Rate for Payer: UHC Dual Complete DSNP |
$9.71
|
| Rate for Payer: UHC Medicare Advantage |
$9.71
|
| Rate for Payer: UMR Bronson Commercial |
$10.58
|
|
|
CHG HETEROPHILE ANTIBODIES SCREEN
|
Professional
|
Both
|
$15.00
|
|
|
Service Code
|
HCPCS 86308
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$9.75 |
| Rate for Payer: Aetna Commercial |
$6.94
|
| Rate for Payer: Aetna Medicare |
$5.39
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$7.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$6.94
|
| Rate for Payer: BCBS Complete |
$6.00
|
| Rate for Payer: BCBS MAPPO |
$5.18
|
| Rate for Payer: BCN Medicare Advantage |
$5.18
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cofinity Commercial |
$7.46
|
| Rate for Payer: Cofinity Commercial |
$6.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$5.18
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$5.44
|
| Rate for Payer: Nomi Health Commercial |
$6.22
|
| Rate for Payer: PACE SWMI |
$5.18
|
| Rate for Payer: PHP Commercial |
$7.25
|
| Rate for Payer: PHP Medicare Advantage |
$5.18
|
| Rate for Payer: Priority Health Cigna Priority Health |
$9.75
|
| Rate for Payer: Priority Health Medicare |
$5.18
|
| Rate for Payer: UHC Dual Complete DSNP |
$5.18
|
| Rate for Payer: UHC Medicare Advantage |
$5.18
|
| Rate for Payer: UMR Bronson Commercial |
$6.90
|
|
|
CHG HYSTEROSALPINGOGRAPHY RS&I
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
HCPCS 74740
|
| Min. Negotiated Rate |
$61.20 |
| Max. Negotiated Rate |
$116.94 |
| Rate for Payer: Aetna Commercial |
$108.82
|
| Rate for Payer: Aetna Medicare |
$84.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$116.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$108.82
|
| Rate for Payer: BCBS Complete |
$61.20
|
| Rate for Payer: BCBS MAPPO |
$81.21
|
| Rate for Payer: BCN Medicare Advantage |
$81.21
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cash Price |
$122.40
|
| Rate for Payer: Cofinity Commercial |
$116.94
|
| Rate for Payer: Cofinity Commercial |
$108.82
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$81.21
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$85.27
|
| Rate for Payer: Nomi Health Commercial |
$97.45
|
| Rate for Payer: PACE SWMI |
$81.21
|
| Rate for Payer: PHP Commercial |
$113.69
|
| Rate for Payer: PHP Medicare Advantage |
$81.21
|
| Rate for Payer: Priority Health Cigna Priority Health |
$99.45
|
| Rate for Payer: Priority Health Medicare |
$81.21
|
| Rate for Payer: UHC Dual Complete DSNP |
$81.21
|
| Rate for Payer: UHC Medicare Advantage |
$81.21
|
| Rate for Payer: UMR Bronson Commercial |
$70.38
|
|
|
CHG IAADIADOO INFLUENZA
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS 87804
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$23.83 |
| Rate for Payer: Aetna Commercial |
$22.18
|
| Rate for Payer: Aetna Medicare |
$17.21
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.18
|
| Rate for Payer: BCBS Complete |
$12.00
|
| Rate for Payer: BCBS MAPPO |
$16.55
|
| Rate for Payer: BCN Medicare Advantage |
$16.55
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cofinity Commercial |
$23.83
|
| Rate for Payer: Cofinity Commercial |
$22.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.38
|
| Rate for Payer: Nomi Health Commercial |
$19.86
|
| Rate for Payer: PACE SWMI |
$16.55
|
| Rate for Payer: PHP Commercial |
$23.17
|
| Rate for Payer: PHP Medicare Advantage |
$16.55
|
| Rate for Payer: Priority Health Cigna Priority Health |
$19.50
|
| Rate for Payer: Priority Health Medicare |
$16.55
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.55
|
| Rate for Payer: UHC Medicare Advantage |
$16.55
|
| Rate for Payer: UMR Bronson Commercial |
$13.80
|
|
|
CHG IAADIADOO RESPIRATORY SYNCTIAL VIRUS
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS 87807
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$18.86 |
| Rate for Payer: Aetna Commercial |
$17.55
|
| Rate for Payer: Aetna Medicare |
$13.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$18.86
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.55
|
| Rate for Payer: BCBS Complete |
$7.20
|
| Rate for Payer: BCBS MAPPO |
$13.10
|
| Rate for Payer: BCN Medicare Advantage |
$13.10
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cofinity Commercial |
$18.86
|
| Rate for Payer: Cofinity Commercial |
$17.55
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13.10
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$13.76
|
| Rate for Payer: Nomi Health Commercial |
$15.72
|
| Rate for Payer: PACE SWMI |
$13.10
|
| Rate for Payer: PHP Commercial |
$18.34
|
| Rate for Payer: PHP Medicare Advantage |
$13.10
|
| Rate for Payer: Priority Health Cigna Priority Health |
$11.70
|
| Rate for Payer: Priority Health Medicare |
$13.10
|
| Rate for Payer: UHC Dual Complete DSNP |
$13.10
|
| Rate for Payer: UHC Medicare Advantage |
$13.10
|
| Rate for Payer: UMR Bronson Commercial |
$8.28
|
|
|
CHG IAADIADOO STREPTOCOCCUS GROUP A
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
HCPCS 87880
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$23.80 |
| Rate for Payer: Aetna Commercial |
$22.15
|
| Rate for Payer: Aetna Medicare |
$17.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$23.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$22.15
|
| Rate for Payer: BCBS Complete |
$11.60
|
| Rate for Payer: BCBS MAPPO |
$16.53
|
| Rate for Payer: BCN Medicare Advantage |
$16.53
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cash Price |
$23.20
|
| Rate for Payer: Cofinity Commercial |
$23.80
|
| Rate for Payer: Cofinity Commercial |
$22.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$16.53
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$17.36
|
| Rate for Payer: Nomi Health Commercial |
$19.84
|
| Rate for Payer: PACE SWMI |
$16.53
|
| Rate for Payer: PHP Commercial |
$23.14
|
| Rate for Payer: PHP Medicare Advantage |
$16.53
|
| Rate for Payer: Priority Health Cigna Priority Health |
$18.85
|
| Rate for Payer: Priority Health Medicare |
$16.53
|
| Rate for Payer: UHC Dual Complete DSNP |
$16.53
|
| Rate for Payer: UHC Medicare Advantage |
$16.53
|
| Rate for Payer: UMR Bronson Commercial |
$13.34
|
|
|
CHG IAAD IA SEVERE AQT RESPIR SYND CORONAVIRUS
|
Professional
|
Both
|
$41.00
|
|
|
Service Code
|
HCPCS 87426
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$50.88 |
| Rate for Payer: Aetna Commercial |
$47.34
|
| Rate for Payer: Aetna Medicare |
$36.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.34
|
| Rate for Payer: BCBS Complete |
$16.40
|
| Rate for Payer: BCBS MAPPO |
$35.33
|
| Rate for Payer: BCN Medicare Advantage |
$35.33
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cash Price |
$32.80
|
| Rate for Payer: Cofinity Commercial |
$50.88
|
| Rate for Payer: Cofinity Commercial |
$47.34
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.33
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$37.10
|
| Rate for Payer: Nomi Health Commercial |
$42.40
|
| Rate for Payer: PACE SWMI |
$35.33
|
| Rate for Payer: PHP Commercial |
$49.46
|
| Rate for Payer: PHP Medicare Advantage |
$35.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$26.65
|
| Rate for Payer: Priority Health Medicare |
$35.33
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.33
|
| Rate for Payer: UHC Medicare Advantage |
$35.33
|
| Rate for Payer: UMR Bronson Commercial |
$18.86
|
|
|
CHG IAADI BORDETELLA PRTUSSIS/PARAPRTUSSIS
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS 87265
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$28.60 |
| Rate for Payer: Aetna Commercial |
$16.05
|
| Rate for Payer: Aetna Medicare |
$12.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$17.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$16.05
|
| Rate for Payer: BCBS Complete |
$17.60
|
| Rate for Payer: BCBS MAPPO |
$11.98
|
| Rate for Payer: BCN Medicare Advantage |
$11.98
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cash Price |
$35.20
|
| Rate for Payer: Cofinity Commercial |
$17.25
|
| Rate for Payer: Cofinity Commercial |
$16.05
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$11.98
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$12.58
|
| Rate for Payer: Nomi Health Commercial |
$14.38
|
| Rate for Payer: PACE SWMI |
$11.98
|
| Rate for Payer: PHP Commercial |
$16.77
|
| Rate for Payer: PHP Medicare Advantage |
$11.98
|
| Rate for Payer: Priority Health Cigna Priority Health |
$28.60
|
| Rate for Payer: Priority Health Medicare |
$11.98
|
| Rate for Payer: UHC Dual Complete DSNP |
$11.98
|
| Rate for Payer: UHC Medicare Advantage |
$11.98
|
| Rate for Payer: UMR Bronson Commercial |
$20.24
|
|
|
CHG IADNA CHLAMYDIA TRACHOMATIS AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 87491
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.02
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Nomi Health Commercial |
$42.11
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
CHG IADNA MULTIPLE ORGANISMS DIRECT PROBE TQ
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS 87800
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$62.88 |
| Rate for Payer: Aetna Commercial |
$58.52
|
| Rate for Payer: Aetna Medicare |
$45.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$62.88
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$58.52
|
| Rate for Payer: BCBS Complete |
$33.20
|
| Rate for Payer: BCBS MAPPO |
$43.67
|
| Rate for Payer: BCN Medicare Advantage |
$43.67
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cash Price |
$66.40
|
| Rate for Payer: Cofinity Commercial |
$62.88
|
| Rate for Payer: Cofinity Commercial |
$58.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$43.67
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$45.85
|
| Rate for Payer: Nomi Health Commercial |
$52.40
|
| Rate for Payer: PACE SWMI |
$43.67
|
| Rate for Payer: PHP Commercial |
$61.14
|
| Rate for Payer: PHP Medicare Advantage |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$53.95
|
| Rate for Payer: Priority Health Medicare |
$43.67
|
| Rate for Payer: UHC Dual Complete DSNP |
$43.67
|
| Rate for Payer: UHC Medicare Advantage |
$43.67
|
| Rate for Payer: UMR Bronson Commercial |
$38.18
|
|
|
CHG IADNA NEISSERIA GONORRHOEAE AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS 87591
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$50.53 |
| Rate for Payer: Aetna Commercial |
$47.02
|
| Rate for Payer: Aetna Medicare |
$36.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$50.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$47.02
|
| Rate for Payer: BCBS Complete |
$30.80
|
| Rate for Payer: BCBS MAPPO |
$35.09
|
| Rate for Payer: BCN Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cash Price |
$61.60
|
| Rate for Payer: Cofinity Commercial |
$50.53
|
| Rate for Payer: Cofinity Commercial |
$47.02
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$35.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$36.84
|
| Rate for Payer: Nomi Health Commercial |
$42.11
|
| Rate for Payer: PACE SWMI |
$35.09
|
| Rate for Payer: PHP Commercial |
$49.13
|
| Rate for Payer: PHP Medicare Advantage |
$35.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$50.05
|
| Rate for Payer: Priority Health Medicare |
$35.09
|
| Rate for Payer: UHC Dual Complete DSNP |
$35.09
|
| Rate for Payer: UHC Medicare Advantage |
$35.09
|
| Rate for Payer: UMR Bronson Commercial |
$35.42
|
|
|
CHG IADNA SARS-COV-2 COVID-19 AMPLIFIED PROBE TQ
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
HCPCS 87635
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$96.20 |
| Rate for Payer: Aetna Commercial |
$68.76
|
| Rate for Payer: Aetna Medicare |
$53.36
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$73.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$68.76
|
| Rate for Payer: BCBS Complete |
$59.20
|
| Rate for Payer: BCBS MAPPO |
$51.31
|
| Rate for Payer: BCN Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$73.89
|
| Rate for Payer: Cofinity Commercial |
$68.76
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$51.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$53.88
|
| Rate for Payer: Nomi Health Commercial |
$61.57
|
| Rate for Payer: PACE SWMI |
$51.31
|
| Rate for Payer: PHP Commercial |
$71.83
|
| Rate for Payer: PHP Medicare Advantage |
$51.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$96.20
|
| Rate for Payer: Priority Health Medicare |
$51.31
|
| Rate for Payer: UHC Dual Complete DSNP |
$51.31
|
| Rate for Payer: UHC Medicare Advantage |
$51.31
|
| Rate for Payer: UMR Bronson Commercial |
$68.08
|
|
